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Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X |
| NPI Number | 1013310945 |
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| LBN Legal business name | AMANDA BROOKE EASTON, CLINICAL PROFESSIONAL COUNSELING, LLC | ||||
| Authorized official | AMANDA EASTON - (PRACTICE OWNER AND MANAGER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 10/07/2014 | ||||
| Last updated | 10/07/2014 - About 12 years ago | ||||
| Identifiers |
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AMANDA BROOKE EASTON, CLINICAL PROFESSIONAL COUNSELING, LLC